Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Dec 1991
Weaning from mechanical ventilation: old and new strategies.
The strategies available for weaning patients from mechanical ventilation are many: T-piece mode, SIMV, PSV, and combinations of each. T-piece trials alternating with SIMV or AC provide periods of spontaneous breathing with rest on the ventilator. ⋯ PSV weaning alone or in combination with SIMV or T-piece trials reduces work of breathing, promotes respiratory muscle training, and improves patient-ventilator interaction. Schuster states "the specific weaning technique employed is often less important than the care with which it is applied."
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Crit Care Nurs Clin North Am · Dec 1991
Prolonged ventilator dependence: economic and ethical considerations.
Patients who receive ventilator treatment tend to be older and sicker than ever before, factors that contribute to the complexity of ventilator weaning. The provision of prolonged ventilator support entails a commitment of expensive hospital resources, yet survival is often poor. ⋯ Decisions to withhold or withdraw mechanical ventilation must be made with full knowledge and understanding of relevant ethical principles. If ventilator support is to be terminated, this should be accomplished according to institutional protocols that take into account these ethical considerations, as well as the medical and legal facts that apply.
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Even though head injury in children is a major health problem facing our nation today, major advances have occurred in our understanding of the epidemiology, pathophysiology, symptomatology, and outcome of these patients. Basic scientists have also contributed to this body of knowledge by demonstrating some unique characteristics of the immature CNS and how it responds to injury. ⋯ Because most pediatric head injuries are nonoperable, it is believed that aggressive medical management to control ICP and prevent secondary injury is responsible for improved outcome. Public education, coupled with legislative support, should prove to be of further benefit.
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Crit Care Nurs Clin North Am · Sep 1991
ReviewInitial assessment and stabilization of the critically injured child.
The care that the child receives during the initial resuscitation and stabilization of a life-threatening injury makes a critical difference in long-term outcome. Children who die as a result of a traumatic injury usually do so because of airway compromise, irreparable CNS injury, or bleeding. Hypoxia is the final common event by which these three kill children. ⋯ The potential for a good outcome is maximized by expert nursing care for the critically injured child. Expert nursing care includes rapid and accurate assessment and interventions during both the primary and secondary surveys. Knowledge of the anatomic and physiologic differences between children and adults guides the nurse in holistic care of pediatric trauma victims; the nurse must also understand and address the emotional needs of the patients and their families.
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Crit Care Nurs Clin North Am · Jun 1991
ReviewInitial management of a patient with extensive burn injury.
During the resuscitation period, a knowledge of burn pathophysiology assists the nurse in conducting thorough assessments and providing effective nursing interventions in the acutely ill patient. The many variables associated with the burn injury contribute to the presentation of each burn patient as one with a unique injury that requires the most vigilant nursing care and expertise. The total dedication required of health care workers as members of a multidisciplinary burn team provides a significant professional challenge. Meeting that challenge appreciably strengthens the chances of burn patient survival.